Psychiatry, by Andrew Jacques ('05)

Working at a local inpatient psychiatric ward for six weeks, I found myself routinely asking questions I only prayed that the patients would not confirm. “Does the FBI or CIA have special messages, missions, or investigations of you?” “Do you hear or see anything I can’t hear or see?” “Have you ever been abused in any way?” “Do you want to hurt or kill yourself or anyone else?” Sadly, so many of my patients answered in the affirmative. I never imagined that asking these questions would become such a routine part of my day.

In psychiatry I found that one of our most important objectives was to correctly diagnose patients, hoping that our classification would provide some insight for them. For instance, most often patients who are suffering from bipolar disorder, commonly called manic depression, lack the knowledge that they are in fact mentally ill. By consistently teaching our patients the signs and symptoms of their illness (racing thoughts, little need for sleep, rapid speech, irritability) and linking these to a specific diagnosis (bipolar disorder), we hopefully provide the patient with the ability to recognize not only their sickness, but also to realize the need to take medications even when he or she feels as if they are well.

Understanding the origin of your patient’s problems become more difficult when you realize that many of our patients have already been labeled by society. Unlike high blood pressure, diabetes, and heart disease, illnesses that require a lifetime of pharmacological treatment, mental illness caries a negative stigma, as if mental disorders are related to some personal transgression. Words like “crazy” are used as derogatory names to describe people that we as society would rather not encounter. The idea of being stuck in a “nut bin” becomes a threat of punishment for people going through emotional difficulty. We use these labels against people in order to remove the responsibility to interact and tolerate them as members of society. No fifth grader teases a smaller child, calling them “diabetic” on the playground at recess, but “wacko” and “nut-case” are common expressions of disdain.

Society portrays people with mental illness as responsible for their malady, so people that need treatment will continually attempt to avoid medical care. Patients are terrified that they will be forced to take an anti-depressant or anti-psychotic for their entire lives, even if it is the one thing that will allow them to function in society, to hold down a job, and to care for their family. Also, medical illnesses like gastro-esophageal reflux disease (GERD) usually do not have a distinctive link to early childhood trauma.

It is so common to hear stories of childhood abuse and neglect from the patients on the psychiatric ward. Tales of horrible dereliction of parental duties, including complicity with sexual abuse and physical harm, which begins the maladaptive pattern of relating to the world that produces the lifelong downward spiral of substance abuse and social maladjustment. Parents are such significant people in our lives, that even when abusive parents fail them, people will seek individuals with similar traits to attempt to relive their past relationships and somehow “fix” them. So abused patients unconsciously seek partners who will abuse them in order to relive some part of their childhood with hopes of correcting whatever portion of their experience they feel was their own fault.

The people with some of the most important labels in mentally ill patients’ lives have repeatedly failed them. Society treats mental illness as “sinful,” when many patients have been deeply emotionally injured by people with the most important labels in their own lives, such as “mom” and “dad.” These patients have been told by society that they are “crazy,” “odd,” and “stupid.” Now I give them a diagnosis like “depressive disorder, severe and recurrent with psychotic features.” I hope my six weeks was worth the paper on which I recorded my ideas and the choked-back tears, because I have to admit I wasn’t always sure if my diagnosing was purely for my patients or simply so that I could go home at night and sleep on my own pillow.